MedicaidAdministrativeHigh impact
07-16-2026 Timely access standards IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Jul 16, 2026
We identified it
Jul 22, 2026
Summary
Molina Healthcare of California issued updated timely access standards for Medi-Cal and Marketplace plans across seven California regions, establishing mandatory appointment scheduling timeframes for PCPs, specialists, behavioral health providers, and ancillary services. The policy requires 24/7 availability with after-hours backup coverage and specifies response times for phone calls, office wait times, and emergency protocols. This is a regulatory compliance advisory affecting all network providers in the specified service areas.
Action Required
IMMEDIATE (effective 07-16-2026): All medical billing and front office staff must implement the following compliance measures: (1) Billing team: Configure billing system to track and ensure compliance with appointment scheduling timeframes—PCP routine/non-urgent (10 business days), PCP urgent without prior auth (48 hours), PCP urgent with prior auth (96 hours), specialist routine (15 business days), specialist urgent without prior auth (48 hours), behavioral health routine (10 business days), ancillary services (15 business days). (2) Front desk/scheduling staff: Ensure appointment scheduling system captures reason for visit to properly route to correct timeframe; implement phone answer time tracking to meet 30-second standard during office hours; establish callback protocol to respond to member calls within same business day. (3) Providers: Document medical necessity in patient record if extending wait times beyond standards to demonstrate no detrimental health impact. (4) All sites: Verify 24/7 after-hours answering service or recorded message is active (voicemail alone is non-compliant); post regular office hours; maintain minimum 20 hours/week availability at primary care sites. (5) Initial Health Appointments (IHA) for new Medi-Cal members: Implement tracking for 120-calendar-day enrollment deadline with AAP periodicity compliance for pediatric members. Molina monitors compliance and will implement corrective actions for non-compliance. Refer to MHC Medi-Cal Manual Chapter 7 and Marketplace Manual Chapter 10 for detailed requirements. Contact Molina Quality at (888) 562-5442 or Provider Relations for questions.